Possible Solutions
Past and Present ProgramsEight causes of homelessness were commonly identified by service providers in Durham: a changing economy, a lack of affordable housing, a lack of job training programs, addiction and substance abuse, mental illness, lack of voice, violence/trauma, and interpersonal factors. Each of these causes is described below in more detail.
Transitioning from a manufacturing industry of primarily tobacco and textile to a health and service industry is the most significant change that almost all service providers indicated. Although these changes occurred over time and most of them in the past, they have significant effects in Durham. One of the negative effects is increasing the number of homeless people. Service providers identified the economy because the new industry requires high-tech job skills, and the demand for other, more traditional workers has been reduced dramatically. Thus, not only the workers employed in tobacco and textile manufacturing, but also other low-skill workers in Durham have to face the unavailability of employment. One provider said, "If there were manufacturing jobs, blue-collar jobs, and housing, we would not have the kind of homelessness we have." As a result, growing unemployment has contributed to increased poverty among certain segments of Durham's population, as well as to the homeless situation. Another provider mentioned, "At one time, tobacco manufacturing sustained everything in Durham. So you had working…job, good paying jobs, you know, and you're talking about jobs that paid well without a high school diploma. Then when that was gone, and there was nothing else to replace it, it seems like to me, that was the beginning of the spiral effect that created some of the homelessness." Another reason for homelessness that some providers mentioned is the increasing expense of housing, which is keeping pace with market demands from the growing number of high-tech skilled workers with bigger salaries in Durham. Many people retain jobs but become homeless since their wages do not keep up with the growing cost of housing.
"There is not enough affordable housing in Durham. There are many people at the shelter who are homeless and may be working but they simply can't find an affordable place to live." As mentioned above, increasing housing prices are a big cause of homelessness. One service provider mentioned one of the reasons leading to the increase in housing prices is "retaliation of the landlords" by raising rents when the City requires repairs. In order to compensate for these increased costs, "they increase the rent to pay for the repairs that the City ordered them to do…then you're talking about a person that barely probably could pay the rent that they were."
However, homelessness is not fully explained by a lack of affordable housing. One provider who works for a housing service felt that low-income residents are still able to find affordable housing through her agency. But in general, service providers thought that the availability of low-rental housing is far below the demand of low-income people.
The demand for high-tech skilled workers in Durham is always high. As one provider said, "Anybody who has skills and is willing to work certainly can work." The problem is that many homeless or low-income individuals lack the kind of skills and education that are required. Most providers realize the very limited resources for job training in Durham, especially training for low educated and low skilled laborers. They also realize that low education is the main barrier for low-skill workers in seeking high-tech job training. One informant said, " High-tech jobs take education, and our public school system doesn't equip people for that. Especially black people." The interviewed service providers feel that there are only a select few programs that offered job-training skills for homeless people. This is, however, perceived by many providers as an integral component that is needed to assist community members move back into a stable lifestyle.
Most service providers spoke about addiction and substance abuse during interviews. Many felt that addiction to alcohol, crack cocaine and/or heroin are contributing factors to the causes of homelessness in Durham, or often accompany the condition of being without a permanent residence. The idea that people in severe circumstances would self-medicate as a coping mechanism was discussed, as well as the recognition that mental health issues are often related to substance abuse. One person told us she felt that: "a lot of the people are homeless because of addiction…you know, many people who are addicted because they are self-medicated for mental illness. I think there's a lot of dual diagnosis involved."
There seemed to be a general agreement among service providers that the Shelter is not able to offer adequate services for people with addictions, nor are there enough rehabilitation programs available to low income people or those in severe circumstances. One provider, who works through a religious organization to provide transitional housing for people, said that in order to be eligible for services with his agency people must be willing to commit to a recovery program for one year and attend regular counseling sessions. He feels that there is a desperate need for more of these kinds of programs in Durham, that integrate substance abuse counseling with other services, and that without a multi-level approach people would find it difficult to end the cycle of homelessness.
Finally, Durham is thought by some service providers to have a flourishing drug trade. One interviewee mentioned that Durham has a nickname as "the heroin highway." An interviewed law enforcement officer said "there is a growing presence of crack cocaine in the area, and heroin is around. Alcohol abuse is a big problem too, especially because it's cheaper to get and more readily available." This interviewee also voiced the opinion that drug and alcohol addiction, along with mental illness, are the underlying causes of homelessness in Durham.
Almost all of the service providers interviewed talked about the prevalence of mental illness among the homeless population. As mentioned above, many felt that mental illness is intertwined with substance abuse. One interviewee who had provided direct counseling for the Durham Shelter for H.O.P.E. described what she encountered: "There is a fair amount of undiagnosed depression, bi-polar disorder and schizophrenia. In the Durham Shelter [for H.O.P.E., I encounter a lot of psychosis. A lot of manic rage." Service providers expressed concern over the scarcity of mental health services that are available for low income and homeless people, as well as the fact that without insurance, many people are not eligible for treatment services.
Service providers often recognized systemic causes of mental health issues and substance abuse, and placed these in a larger context by reporting, "With Medicaid being so restrictive in North Carolina, medication becomes the main problem. Budget cuts [in Medicaid] have been a real issue. They have caused an increase in drug related and mental health problems. These cuts have resulted in people not getting their meds."
Others echoed the problem of under- and uninsured people finding treatment: "Okay, so I called Duke Addiction Treatment because it would be perfect for this guy. And talked with a social worker there and he was all excited, you know, very accommodating, and then he got to the point about what kind of insurance my client had. And I said, 'well this is so exciting, why I'm calling, we just got him Medicare' (because up till then he hadn't had any insurance). 'Oh…and there was this pause…we're not allowed to take Medicare patients.' Right."
One interviewee who works directly with low income and transient residents felt that many of her clients, partly due to their mental illness and marginalized situations, had difficulty accessing the health care services they require, and as a result, many disorders are left undiagnosed and untreated. Another dilemma addressed by several interviewees is the fact that unless an adult is willing to request mental health services, they can't be forced to receive help. There is a legal exception to this, and a police officer explained, "We don't have the authority to take them to a hospital unless we can prove they're a danger to themselves or others… they rarely admit and see that their mental illness is getting the best of them. It's a hard situation to deal with."
Several people mentioned the difficulty in trying to help someone when they don't think they need help, and one interviewee told us; "the de-institutionalized are able to care for themselves as long as they are taking their medicine. Now when they are out of the hospital, they will be feeling well - as long as they take their meds. Then they will begin to feel as though they can manage without the drugs and they relapse with nobody to realize what is going on and help them out."
Many providers feel that mental illness goes hand in hand with homelessness in Durham, and that it is difficult to know which causes which. As one provider summarized in regard to this conundrum: "I keep saying, which came first, the chicken or the egg?" The complexity of dual diagnosis and the fact that addiction often accompanies mental illness and requires a multi-level approach was also mentioned. "It doesn't do any good to put someone in an addiction treatment program if they have mental illness. It doesn't do any good to treat someone for mental illness if they also have addiction."
Service providers often recognize the need for more integrated services, and services that reach along a continuum of care, rather than just piece meal programs to address issues of mental health. The lack of these services coupled with the denial that often accompanies mental illness or the inability to seek help was suggested as one cause that keeps people in a cycle of homelessness. A former Shelter for H.O.P.E Chaplain described this phenomenon; "But mostly the homeless people who are mentally ill cycle back and forth through the Adult Admission Unit at John Umstead Psychiatric Hospital where they may stay three weeks or a month and then they're back to the shelter until they get picked up by the Sheriff again and then they're back…"
Closely related to mental illness and addiction in Durham is the lack of voice homeless people experience. As mentioned above, greater access to care is recognized as a need by many service providers. There are many barriers to attaining care by those who lack education, self-confidence and respect in the larger society. One informant said, "One of the real problems is a lack of listening. You know, poor people, indigent people in general, particularly those known to be homeless, are treated like dirt."
One provider served as an advocate for homeless people and would accompany them when they went to appointments to ask for social or mental health services. She reported that her clients had been turned down frequently for services, often because they lack the knowledge or skills to negotiate for what they need in a bureaucratic system. She said, "It's really shocking to me, the number of people who are in the shelter because they're physically or mentally incapable of working but can't get disability and aren't organized enough to work the system. Get a lawyer and you know, go through the appeal process. I think it's criminal."
Another service provider who serves in local government was one of many who expressed concern over the lack of representation by those in need on Boards of community organizations and government agencies. She emphasized this view in her interview, "If you're going to address a problem, you need the people who are [at] the heart of the problem to be at the table…you need the homeless population at the table." Many service providers echoed this sentiment, during interviews, in planning meetings for the Community Forum, and at the Community Forum.
Informants identified trauma, domestic abuse and violence as contributing causes to homelessness. One social worker estimated that approximately one third of the homeless population in Durham are veterans, and pointed out that many of them have Post Traumatic Stress Disorder from being in combat. Another provider made the link between homelessness itself and resultant increased levels of stress, "I would say that the prevalence of undiagnosed and untreated post-traumatic stress disorder is very high. Because being homeless is traumatizing - from the level of violence and the threat of violence in their lives. And it seems to me to be very parallel to what battered women go through." She also discussed the high proportion of homeless people she had observed who were affected by personal violence in our society, "That really surprised me, how high a proportion of people have become homeless because of traumatization, frequently losing a loved one to violent homicide." Others, including a service provider involved in housing for women and women with children, repeated the theme of violence. He reported that many of the single women his agency deals with have been sexually and physically abused by family members or partners.
Two interviewees mentioned that usually homeless people are viewed as being lazy. Another provider asserted that one reason just might be bad decisions, saying, "It's hard to solve the complexity of humans when adults make bad choices - but people have the right to make bad choices - learn coping skills." Many attributed the causes of homelessness to psychiatric or personality disorders connected in some fashion with difficult relationships that would lead into homeless situations.
Smaller groups of people who are homeless for the first time often find their predicament due to unforeseen circumstances such as medical expenses, medical disability, or lack of funds to repair damaged properties.
Apart from that, another cause mentioned was the lack of social networks between those who are in need with other people in the community that could help them. As a service provider mentioned, "even a lower-class person with no wallet or ID has somebody they could call collect in Walla Walla, WA to wire them money for a bus ticket - those resources aren't available to [the homeless folk]." Another provider said, "Parents die, parents can't afford brothers and sisters, friends [fade away], gradually people who can help them have shrunk to zero…congregations generally will go out of their way to help people in their community, but not a random person." Another informant mentioned that the three things that prevented homelessness were churches, relatives, and friends, because these three together insure ample resources to prevent someone they know from losing their home.
A few providers mentioned the culture of self-reliance or stigma of being needy resulting in people being embarrassed to ask for help, which makes their situation worse. People internalize low expectations and do not have the ability to envision what could be different about their lives.
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